Welcome to the EXCEL 2012 Intranet Forms Page.    

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Employment Forms

Employment Application I-9 Form Direct Deposit Consumer Authorization Form Emergency Contact Form 2012 Benefits Enrollment/Overview

Healthcare

MMO HSA Benefit Summary2012 MMO PPO Benefit Summary 2012 MMO Enrollment Form HSA Payroll Contribution Form 2012 FlexBank HRA Reimbursement Claim Form FlexBank Enrollment Information FlexBank Flexible Spending Account Brochure FlexBank MyBeeny.com Information Flexible Spending Account Enrollment Form FlexBank Employee Direct Deposit Authorization Form

Dental

Dental Care Plus Benefit Summary Dental Care Plus Enrollment Form.pdf Dental Care Plus Student Status Verification

Vision Insurance

EyeMed Plan Description EyeMed Enrollment Form

Tax Forms

W4 Federal Form State of Ohio Tax Form State of NC Tax Form Illinois-W-4.pdf

Life Insurance

Company paid Life Plan Description Company paid Long Term Disability Plan Description Company paid Life, Short Term Disability Plan Description Voluntary (employee paid) Life Benefit Plan Description & Rates Voluntary Life Benefit Enrollment Form

Additional Forms

Training/Education Authorization Form Vacation Buy Back Family Medical leave of Absence (FMLA) Form ADP Direct Deposit.pdf Worker’compensation First Report of Injury call 1-888-627-7586